HRT & Arimidex...this one's for you TNT!

TNT:

I'm a virgin to this board but have to say after reviewing many of the posts, that this board is quite unique...less flames, good info, friendly, etc. and I was also psyched about the Over 30 Forum. Those of us with wisdom must band together!

Now a little about me, and my question. I'm 34 yo, and about a year and a half ago, I was referred to a doctor by a friend, to have my blood levels checked because I felt like I was losing my mind, no memory, fatigue, couldn't focus mentally, withdrawn personality, couldn't gain any muscle, fat deposits in all the wrong places, etc. Anyways...doc ran a full blood panel, PSA, etc. for review and came back with a diagnosis of hypogonadism as my T levels were 230ng/dl...which obviously sucks. The other thing was my estrodiol was 93 pg/ml (whatever the common measurement is...can't remember) So he started me out on 200mg of cyp every 10 to 14 days...which resulted in blood levels of around 840 ng/dl or so. He watched me like a hawk and my estrodiol went down slightly to like 89 and stayed there. I noticed that my nips started to itch and the doc was concerned about the levels of estrodiol so he put me on arimidex 1 mg eod which works to keep the "females" in check at about 15 to 20.

Now for my problem. I no longer have access to this physician as I moved far away. I found a local physician who would work with me, but he immediately took me off the shots and put me on the patch which didn't do crap...then on to androgel...1st 5mg, then 10mg and now 15mg applied daily. I had a blood level of 356 ng/dl on the 5mg, then on the 10mg my blood level was 319 ng/dl...which still sucks so he wants me to try the 15mg. The interesting thing is when I asked about arimidex to control the "females" he was like "what"...hadn't even heard of it being prescribed to men...so he would not write the script. He believes my estrodiol levels would come down on their own over time...and refuses to even check for them.

How familiar are you with "estrogen management" as part of HRT treatment? Unmedicated, I tend to run in the 90's which scares the hell out of me. It is certainly outside of the range considered normal by most labs. So is my doc thinking straight...or should I find a new one that will manage not only the T level, but also the nasty "females". The last thing I need is a nice set of hooters!

Anyways...I really enjoy your posts...and hope I can contribute. I've tried the patches, shots, and the gel...thus far prefer the shots but hate the way the medical establishment is scared to death to prescribe them. And BTW...HRT is a lifetime committment, one that has dramatically changed me physically but more importantly, mentally...I have my mind and memory back....but I have to deal with this crap the rest of my life. So for those reading this post...educate yourselves and make wise decisions....but be careful.

Thanks in advance for any thoughts you guys have on the issue!

LDSlifter

:angel2:

Wow . . . I feel like you've given me your virginity (as in "virgin to the board"). Don't take that the wrong way; I assume from your user name that you're a good Mormon. :D

Seriously, a big welcome - and for your first post, a substantive one.

Moreover, you actually came up with something I hadn't heard of: Estradiol levels (note the correct spelling). According to Quest Labs, the estradiol test "is useful in the differential diagnosis of menstrual abnormalities and sexual immaturity in females, estradiol-secreting tumors, and feminization in males." Could be a handy test to have . . . In fact, now that I've found out about it, I'll check that box off next time I have some labwork done. (No complaints, but now you've got me curious.)

Your former doctor sounds like he had his act together. The dose he prescribed is classical for HRT (hormone replacement therapy), and it sounds like it has done the trick. Your test levels have obviously improved, but I'd be curious to see how your peak versus trough levels are. (Trough levels are those right before an injection is due; peak levels are done 24-48 hours after the injection.) It is very unusual to find a physician who is even literate about treating gynocomastia, let alone one who knows about prescribing Arimidex.

The problem I perceive is with your new physician, who obviously doesn't know the meaning of, "If it ain't broke, don't fix it." Most physicians do exactly the opposite when it comes to HRT - they prescribe Androgel first and, if doesn't work, they move to patches or injections. The interesting this is that you got a lower TT (total testosterone) level with 10 mg. than you did with 5 mg. Incidentally, this mimics my limited experience with Androgel, which I have largely found to be a joke. (And a very expensive one, at an average retail of $165 per 5 mg. per 30 days. If you don't have a fixed-rate prescription plan, it's a rip-off.)

The problem is that your were obviously having good readings from the testosterone injections. Why did the new doctor bother to change the routine at all? (Actually, that's a rhetorical question. The answer appears to be obvious: Pharmaceutical reps are marketing Androgel and patches more heavily than injectable test. In other words, whether your physician is even aware of it on his part, I sense a conflict of interest by the fact that he is obviously not prescribing the best product for you.)

As for the "e" factor, it appears that he doesn't have a clue. The reason he would not prescribe Arimidex is obvious: the drug's only clinical indication (reason it is prescribed) is for the treatment of advanced breast cancer in post-menopausal women. (Seriously.) Some physicians are willing to go outside the box, others are not.

The one thing you did not mention is whether your doctors, both old and new, were general practitioners/family physicians or whether they were specialists. In most cases, the doctors with the best knowledge of HRT issues tend to be endocrinologists, but occasionally you'll run across a general practitioner who is alert to these issues. (There are also some physicians, both general and specialized, who cross over into the realm of geriatric medicine, but most of the guys on the forum are not quite there yet. And that's not a slam, because with any degree of luck, at some point we'll all eventually be there.)

Obviously, the solution is to find someone more like your old doctor, who had a good handle on the situation. He did apropriate tests, came up with what appears to be an accurate diagnosis, and prescribed correctly and sensibly (unlike some of the anti-aging doctors we have heard about here recently). Which, again, makes him an exception to the rule - most doctors don't have a clue when it comes to HRT. But find someone who is comfortable doing what is right not what is fashionable. For you, it would appear that test injections are the way to go - Androgel and Androderm may be fashionable, but they're obviously not effective for you.

Finally, in terms of HRT being a lifetime commitment, you're quite correct. But when you're lookg at 4 oz. of water in an 8 oz. glass, you've got a choice: You can see a half-empty glass of water, or a half-full glass of water. There are a lot of guys who would jump hoops to be where you're at in terms of being able to shoot test legally - I regularly hear from guys who ask, "How can I get my test levels low enough to have it prescribed?" (And you're right - they don't have a clue as to what it's about either.)

Once again, LDS, welcome to the merry band of A.R. marauders. :\/:

TNT:

Thanks for your post. There's a club on the web for hypogonadal dudes...I've spent a lot of time helping them to ask the right questions. The most common problem being the physician's lack of experience in hormones...particularly the "females" which I coined to mean the "estrogens" and "prolactin".

With regards to the Androgel and Androderm promotions...you are totally correct. Doctors get all kinds of perks from the drug companies to promote their products. My current Doc happens to be the largest prescriber of Androgel in my area. He is a family physician but treats approximately 500 men with HRT..he has a huge practice. Maybe he gets kickbacks? If I didn't have insurance...my monthly Androgel costs would be $495 or I can get a two month supply of cyp from a compounding pharmacy for $41...delivered to my door. Hmmmm....I smell a conspiracy or at least a new set of golf clubs.

My current doc doesn't like the cyp because he believes the supra levels which occur at the beginning of the injection are unhealthy. When I was on shots...I got to were I could time my injections just right so I did not experience the peaks and valleys....then I freakin had to move...duh!

My current doc did just as you said the first time I mentioned Arimidex...he turned to his desk reference manual to look it up (he had never even heard it) then said...this stuff is for treating breast cancer in women....why the heck would you be taking it. I tried to educate him..but you know how that goes...doctors have egos the size of texas...and according to him...my previous doctor was a quack! I couldn't believe it....here he is treating over 500 male patients and he never checked the "females". Take a look around...high estrogen levels are rampant in old age men....and now we know why old men grow saggy boobs and have a pot belly. It's called andropause...not enough testosterone and too much freakin estradiol...and dangit...doctors need to educate themselves for crying out loud and start treating people appropriately...ok...i'll get off my box of Tide.

And you are correct on the religious affiliation...LDS aka Mormon. I use to have a different online identity but when you visit bodybuilding chatrooms to talk training, diet and supps, I was getting all kinds of cybersex requests which I found to be offensive...so by putting LDS in my online name...they run like hell!

Here's some interesting info from www.lef.org on estrogen and men. Also as you asked, my previous physician was a general MD who also specialized in treating hormone irregularities for both men and women. He was a progressive thinker...not obscenely progressive...but open minded enough to treat the whole picture. I felt much better under his care than I do with the current "text book" physician. I hate schmucks who are too afraid to step out of the box a little...for pete's sake...at least into the gray area!

Here's the article:

"Too Much Estrogen

The most significant hormone imbalance in aging men is a decrease in free testosterone, while estrogen levels remain the same or increase precipitously. As men grow older, they experience a variety of mechanisms from the dual effects of having too little testosterone and excess estrogen. The result is a testosterone-estrogen imbalance that directly causes many of the debilitating health problems associated with normal aging (1-12, 28).

One cause of hormone imbalance in men is that their testosterone is increasingly converted to estrogen. One report showed that estrogen levels of the average 54-year-old man are higher than those of the average 59-year-old woman (1, 5, 13-18, 48). (This thought scared the hell out of me...I picture saggy boobs...ugh!)

The reason that testosterone replacement therapy does not work by itself for many men is that exogenously administered testosterone may convert (aromatize) into even more estrogen, thus potentially worsening the hormone imbalance problem in aging males (i.e., too much estrogen and not enough free testosterone) (21, 26).

Estrogen is an essential hormone for men, but too much of it causes a wide range of health problems. The most dangerous acute effect of excess estrogen and too little testosterone is an increased risk of heart attack or stroke (39-43, 261-270). High levels of estrogen have been implicated as a cause of benign prostatic hypertrophy (BPH) (35-44, 46, 47). One mechanism by which nettle root extract works is to block the binding of growth-stimulating estrogen to prostate cells (42-44, 48-50).

When there is too little testosterone present, estrogen attaches to testosterone cell receptor sites throughout the body and creates many problems in aging men. In youth, low amounts of estrogen are used to turn off the powerful cell-stimulating effects of testosterone. As estrogen levels increase with age, testosterone cell stimulation may be locked in the "off" position, thus reducing sexual arousal and sensation and causing the loss of libido so common in aging men (94, 99, 259).

High serum levels of estrogen also trick the brain into thinking that enough testosterone is being produced, further slowing the natural production of testosterone. This happens when estrogen saturates testosterone receptors in the hypothalamus region of the brain. The saturated hypothalamus then stops sending out a hormone to the pituitary gland to stimulate secretion of luteinizing hormone that the gonads require to produce testosterone. High estrogen can thus shut down the normal testicular production of testosterone (1, 53, 54, 271-277).

One further complication of excess estrogen is that it increases the body's production of sex hormone-binding globulin (SHBG) (280). SHBG binds free testosterone in the blood and makes it unavailable to cell receptor sites (51, 52, 55, 56).

Based on the multiple deleterious effects of excess estrogen in men, aggressive action should be taken to reduce estrogen to a safe range if a blood test reveals elevated levels.

Estrogen (measured as estradiol) should be in the mid- to lower-normal range. If estradiol levels are in the upper one-third of the normal reference range, or above the normal reference range, this excessive level of estrogen should be reduced. Labcorp lists a reference range of between 3-70 pg/mL for estradiol while Quest states a reference range of between 10-50. For optimal health, estradiol should be in the range of 10-30 pg/mL for a man of any age."

Well...TNT...I hope you found the information interesting. Thanks for your warm welcome...I plan to stick around. What do you think...perhaps I should conjure up some extra cash to fly back and forth to my former doctor. I think my nips are starting to itch....CRAP!

Have a good one!

LDSlifter
:angel:

"Have you checked your "females" Today?"

Interesting reading. I'd be curious about the web forum for hypogonadal dudes, as that seems to be becoming a more frequent diagnosis that we're seeing here on A.R. DO you have a URL for this?

I had a feeling that your current doc found out about Arimidex from opening his P.D.R. (Physicians' Desk Reference). This is one of the primary reasons that physicians won't write for any of the traditional drugs used as part of an A.R. cycle (including Nolva, Clomid, etc.) - because they are not "approved uses."

As you are learning, the big challenge is not only finding a doctor who is willing to think outside the box, but one that is apparently willing to think inside the box without bowing to pharmaceutical companies' pressure. The mere notion that this guy is the area's leading prescriber of Androgel raises suspicions about his common sense, let alone his ethics. (By the way, I admit being guilty of not thinking outside the box on some issues - that's one of the main reasons I do not endorse Clomid after a test cycle.)

By the way, I started laughing when I read your rationale for the LDS user name. Profoundly, perhaps, we have one open gay guy on the board - a funny guy who is sometimes misinterpreted (yes, everyone I'm talking about Canes), and he happens to be a geneaologist. (Never mind, everyone, only a Mormon would understand the significance of that.) Just be thankful that you don't get hit with the evangelical antimormon crowd; I haven't seen any "little Walter Martins" around here yet. :D

TNT:

The address to the group is http://groups.yahoo.com/group/hypogonadism2 It was recently converted from a club to a group with tacky banner advertising. Along the way, many of the historic great posts were deleted. I still post every now and then, but not as much as I once did.

There are lots of knowledgeable people in there now who help to answer questions...of course you know how much time it takes.
There's a great group of guys and knowledge there when it comes to hypogonadism. All faiths, professions, backgrounds, lifestyles, etc. Diversity keeps it interesting.

So you thought the LDS thing was funny huh...cool. I don't give a rats behind what people think. I'm not gonna throw religion at anybody unless they ask, but believeyoume I've heard plenty of mormon jokes over the years. Some people get LDS confused with LSD...boy aren't those intelligent people.

Canes..if you're out there drop me a line sometime my wife has her ancestors traced back to the 1500's....it's really fascinating. My wife handles the geneology, I don't have the patience to sit and fill out the geneology charts....dang where's my welbutrin?

Later

LDSlifter

"Have you checked your "females" today?"

Gentlemen, that was some seriously good reading! And we know that this subject would not likely have been broached normally on the boards. Thanks for your insights. BTW, TNT, I'm curous as to your reasons not favoring Clomid usage post cycle.

Quote:

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Originally posted by slackerdude
BTW, TNT, I'm curous as to your reasons not favoring Clomid usage post cycle.

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Because sometimes I have trouble thinking outside the box myself. :D

Seriously, it's because the only clinical indication for Clomid is to induce ovulation in women. Therefore, I'm more resistant to the idea of routinely taking Clomid (just as I am to the idea of routinely taking Arimidex/Nolvadex, which are used for breast cancer in women). It's a guy thing.

I'm always amused when I see cycles in which guys automatically include one or more of these drugs. In almost all cases, they have not experienced gyno, but still tend to include Arimidex/Nolva in their cycle from day one. In the case of Clomid, I've always felt that if you do test, the fact that you will not be horny for a few weeks after the cycle (as the body re-establishes its own natural test levels) is a given, and simply one of the thing sto be dealt with. Having never experienced that kind of readjustment, it also implies (IMHO) that too much test was used in the cycle to begin with; I fail to understand, for example, why some people would even consider shooting 1,000 mg. of test per week, let alone 500 mg. of test per week (which is quite common). On the other hand, I recognize that most guys do not monitor their total test levels when they do a cycle, wheras I do monitor mine, and have seen my own levels go sky high on much less.

I recognize that there is a diversity of opinion on the Clomid and Arimidex/Nolva issues, which is why I'm willing to occasionally explain my position, but not debate it. Therefore, I welcome and respect any other opinions, but will not do an ongoing give-and-take on the issue. :)

TNT,... like always you bring an informative and interesting replys.

I understand totally what you mean about 1000mg test/week cycles.... and yes 500mg/week also..

I have seen people GROW on much lower dosages, and I mean GROW!!! I think it is disappointing that most members tell people,... that 300 mg test/week is too low.. and instruct people to take higher dosages.

I know a particular member who was 20.. who I recommended that he NOT take gear for a few more years. He told me that no matter what he would take it. He had made up his mind. I understand what it is like to be stubborn and just out of your teens(as most of us do).

So I recommended that he take only a low dose like 250mg test/week, and 200mg Boldenone /week. And that would be ample. For a little while he listened... but before long.. he had read other peoples posts and he had decided to take 500 mg/test/week, 400 mg Boldenone/week. And some Dbol to also.

Now this I find disappointing. I have seen members taking LARGE amounts of gear, with less than large results... I thing many people under estimate how anabolic a good DIET is. They look to quickly at AS to get there dream physique, with out putting in the hard miles to get there.

Increase the dose and eventually the amount you gain will taper off, but the risk of side effects will still increase.

It is good to see some people have moderate/sensible views also.

JMO...
Peace